The Use of Computed Tomography Angiography to Define the Prevertebral Vascular Anatomy Prior to Anterior Lumbar Procedures

Abstract Background Computed tomography angiography (CTA) has been widely used for perforator mapping in abdominal-based reconstruction, but it is less widespread in the anterolateral thigh (ALT) flap. However, CTA may be quite useful for ALT planning, as this flap has demonstrated substantial variability in intrapatient bilateral vascular anatomy. This study investigated whether standard use of preoperative CTA resulted in selection of the donor extremity with preferential perforator anatomy, and whether this affected operative time and postoperative outcomes. Methods A retrospective review of 105 patients who underwent proposed ALT flap reconstruction was performed. Seventy-nine patients received bilateral lower extremity CTAs, which were evaluated for dominant perforator anatomy (septocutaneous, musculoseptocutaneous, or musculocutaneous). Donor extremity selection was noted, and predicted perforator anatomy was compared with that encountered intraoperatively. Results Among the 73 patients who received bilateral imaging and ultimately received an ALT, congruent findings between imaging and surgical exploration were observed in 51 (69.8%) patients. Thirty (37.9%) patients had asymmetric perforator anatomy between their bilateral extremities on imaging. Among these, the leg with optimal perforator anatomy was selected in 70% of cases. There were no significant reductions among postoperative complication rates, but selection of the donor site with preferential anatomy was associated with a decrease in operative time (p = 0.049) among patients undergoing extremity reconstruction. Conclusion CTA is a useful tool for optimizing donor site selection for ALT flaps and reducing operative time. We believe that standard use of preoperative CTA in ALTs warrants further consideration.

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Comparative Study of Three Preoperative Imaging Modalities for the Evaluation and Design of Superficial Circumflex Iliac Artery Perforator Flap: Color Doppler Ultrasound, Computed Tomography Angiography and Magnetic Resonance Angiography

Iranian Journal of Radiology ◽

10.5812/iranjradiol.97168 ◽

2020 ◽

Vol 17 (3) ◽

Author(s):

Zhuowei Tian ◽

Shizhe Wang ◽

Yue He ◽

Chunyue Ma

Keyword(s):

Computed Tomography ◽

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Iliac Artery ◽

Computed Tomography Angiography ◽

Color Doppler ◽

Vascular Anatomy ◽

Color Doppler Ultrasound ◽

Tof Mra ◽

Artery Perforator

Background: Superficial circumflex iliac artery perforator (SCIP) flap is a promising reconstructive candidate for head and neck, trunk and extremity reconstruction. In order to reduce intraoperative errors, preoperative planning is essential for evaluation of the possible variations in vascular anatomy of the groin region. However, the use of these modalities has not been compared. Objectives: The three commonly used imaging modalities [color Doppler ultrasound (CDUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA)] were therefore compared in this study for the relative accuracy in the SCIP flap planning. Patients and Methods: This study was conducted on eight patients who underwent CDUS, CTA and MRA [3-dimensional time-of-flight magnetic resonance angiography, (3D TOF-MRA)] and received reconstructions with the SCIP flaps for head and neck defects. The perforators’ locations, courses and calibers were measured or marked for each flap. These imaging preoperative measurements were later compared with intraoperative findings. Results: CDUS, CTA and 3D TOF-MRA were able to effectively identify the courses of the perforators. 3D TOF-MRA was more accurate at measuring the pedicle calibers of SCIP flaps in comparison with CTA and CDUS. Conclusion: Three D-TOF-MRA may be a more valuable imaging modality for the preoperative assessment of the vascular anatomy of SCIP flaps.

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Evaluation of the vascular anatomy of the right-sided colon using three-dimensional computed tomography angiography: a single-center study of 536 patients and a review of the literature

International Journal of Colorectal Disease ◽

10.1007/s00384-016-2627-1 ◽

2016 ◽

Vol 31 (9) ◽

pp. 1633-1638 ◽

Cited By ~ 15

Author(s):

Koji Murono ◽

Kazushige Kawai ◽

Soichiro Ishihara ◽

Kensuke Otani ◽

Koji Yasuda ◽

...

Keyword(s):

Computed Tomography ◽

Computed Tomography Angiography ◽

Three Dimensional ◽

Vascular Anatomy ◽

Review Of The Literature ◽

Single Center ◽

Single Center Study ◽

The Right ◽

Center Study

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Vascular anatomy of the capitate determined by micro-computed tomography angiography

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417714400 ◽

2017 ◽

Vol 42 (9) ◽

pp. 966-967 ◽

Cited By ~ 2

Author(s):

G. Xiong ◽

Z. R. Xiao ◽

W. G. Zhang

Keyword(s):

Computed Tomography ◽

Computed Tomography Angiography ◽

Vascular Anatomy ◽

Micro Computed Tomography

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Use of computed tomography angiography to evaluate the vascular anatomy of the distal portion of the forelimb of horses

American Journal of Veterinary Research ◽

10.2460/ajvr.2004.65.1409 ◽

2004 ◽

Vol 65 (10) ◽

pp. 1409-1420 ◽

Cited By ~ 16

Author(s):

Jennifer N. Collins ◽

Larry D. Galuppo ◽

Helen L. Thomas ◽

Erik R. Wisner ◽

William J. Hornof

Keyword(s):

Computed Tomography ◽

Computed Tomography Angiography ◽

Vascular Anatomy ◽

Distal Portion

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Computed tomography angiography evaluation of acute limb ischemia

VASA ◽

10.1024/0301-1526/a000759 ◽

2019 ◽

Vol 48 (1) ◽

pp. 57-64

Author(s):

Alex Wallace ◽

Yash Pershad ◽

Aman Saini ◽

Sadeer Alzubaidi ◽

Sailendra Naidu ◽

...

Keyword(s):

Computed Tomography ◽

Magnetic Resonance ◽

Computed Tomography Angiography ◽

Vascular Anatomy ◽

Limb Ischemia ◽

Medical Emergency ◽

Acute Limb Ischemia ◽

Surgical Interventions ◽

Presenting Symptoms ◽

Time Treatment

Abstract. Acute limb ischemia (ALI), a subclass of critical limb ischemia, is a medical emergency. The cause of ALI is usually thrombotic or embolic in nature, and the specific etiology often dictates the appropriate therapy. While the diagnosis is a clinical with common presenting symptoms, advances in ultrasound, computed tomography, and magnetic resonance technology have impacted the diagnosis and subsequent therapy. In ALI, the time to revascularization is critical and computed tomography angiography (CTA) provides a highly sensitive and specific technique for rapidly identifying occlusions and precisely defining vascular anatomy prior to interventions. In patients with significant renal disease, magnetic resonance angiography with or without contrast provides effective alternatives at the expense of imaging time. Treatment can include a variety of endovascular or surgical interventions, including thromboembolectomy, angioplasty, or bypass. Proper evaluation of the etiology of the ischemia, affected vasculature, and medical history is critical to select appropriate treatment and improve patient outcomes. Here, we examine the presentation, evaluation, and treatment of ALI and the role of CTA in diagnosis and therapy.

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